Department of Epidemiology and Biostatistics, City University of New York (CUNY) School of Public Health, New York, USA.
Department of Family & Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
Matern Child Health J. 2020 Jul;24(7):845-855. doi: 10.1007/s10995-020-02948-w.
Implementation of community-based healthcare services offering effective contraception, antenatal care (ANC), and treatment for symptomatic children under five has reduced maternal and child mortality in Togo. However, understanding if women are utilizing these services differentially based on social or demographic factors is important. This study identifies whether sexual relationship and socio-demographic factors are associated with healthcare utilization in four health facility catchment areas.
We conducted a cross-sectional household survey of women aged 15-49 in four health facility catchment areas in 2016 (three rural sites, one urban site). We used multivariable Poisson regression to test whether socio-demographic factors and a validated sexual relationship power scale were associated with contraceptive use, ANC visits, and seeking treatment for symptomatic children under five.
Among women not pregnant or desiring pregnancy, older age, lower education, and single relationship status were associated with lower use of effective contraception. Among women who gave birth in two years preceding survey, low relationship power and low wealth quintile were associated with being less likely to attend at least four ANC visits. Women in rural sites were slightly more likely than women in the urban site to report seeking treatment for child under five with malaria, pneumonia, and/or diarrhea symptoms in last 2 weeks.
Interventions in low-resource settings should explore ways to reach women with low health-service utilization to improve contraceptive use, ANC visits, and treatment for sick children. Furthermore, age, education, marital status, wealth status and sexual relationship power must be considered when targeting maternal health behaviors.
ClinicalTrials.gov Identifier: NCT03773913; Date of registration: 12 Dec. 2018.
在多哥，实施以社区为基础的医疗保健服务，提供有效的避孕措施、产前护理（ANC）和五岁以下有症状儿童的治疗，已经降低了母婴死亡率。然而，了解妇女是否根据社会或人口因素的不同而利用这些服务是很重要的。本研究旨在确定性关系和社会人口因素是否与四个卫生机构服务范围内的医疗保健利用相关。
我们于 2016 年在四个卫生机构服务范围内（三个农村地区，一个城市地区）对 15-49 岁的妇女进行了横断面家庭调查。我们使用多变量泊松回归检验社会人口因素和经过验证的性关系权力量表是否与避孕措施的使用、ANC 就诊次数以及五岁以下有症状儿童的治疗有关。
在未怀孕或不希望怀孕的妇女中，年龄较大、教育程度较低和单身关系状况与有效避孕措施的使用较低相关。在调查前两年分娩的妇女中，低关系权力和低财富五分位数与不太可能接受至少四次 ANC 就诊相关。与城市地区的妇女相比，农村地区的妇女更有可能报告在过去两周内为五岁以下儿童因疟疾、肺炎和/或腹泻症状寻求治疗。
在资源匮乏的环境中，干预措施应探索如何接触到低健康服务利用率的妇女，以提高避孕措施的使用、ANC 就诊次数和治疗患病儿童。此外，在针对产妇健康行为时，必须考虑年龄、教育程度、婚姻状况、财富状况和性关系权力。
ClinicalTrials.gov 标识符：NCT03773913；注册日期：2018 年 12 月 12 日。
